The healthy worker effect in US chemical industry workers

Burns, Carol J.; Bodner, Kenneth M.; Jammer, Brenda; Collins, James J.; Swaen, Gerard M. H.

doi:10.1093/occmed/kqq168

Cited by 13 publications

(8 citation statements)

References 17 publications

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“…Since increased age is associated with increased length of military service, the lower mortality in the oldest ages suggests evidence of a Healthy Soldier Survivor Effect (HSSE) – increased time in military service may be providing beneficial health effects. Higher than expected mortality at the youngest ages parallels the association between shorter duration of employment and elevated mortality in HWE studies of the chemical industry [ 28 ]. Additionally, evidence suggests that combat experience may lead younger soldiers to engage in risky and dangerous behaviors such as speeding, drinking and driving, and failure to wear seat belts [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Erosion of the healthy soldier effect in veterans of US military service in Iraq and Afghanistan

Bollinger

Schmidt

Parsons

et al. 2015

Popul Health Metrics

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BackgroundThis research explores the healthy soldier effect (HSE) – a lower mortality risk among veterans relative to the general population—in United States (US) veterans deployed in support of operations in Iraq and Afghanistan (OEF/OIF/OND). While a HSE has been affirmed in other OEF/OIF/OND populations, US veterans of OEF/OIF/OND have not been systematically studied.MethodsUsing US Department of Veterans Affairs (VA) administrative data, we identified veterans who (1) had been deployed in support of OEF/OIF/OND between 2002 and 2011 and (2) were enrolled in the VA health care system. We divided the VA population into VA health care utilizers and non-utilizers. We obtained Department of Defense (DOD) administrative data on the OEF/OIF/OND population and obtained VA and DOD mortality data excluding combat deaths from the analyses. Indirect standardization was used to compare VA and DOD cohorts to the US population using total population at risk to compute the Standardized Mortality Ratio (SMR). A directly standardized relative risk (DSRR) was calculated to enable comparisons between cohorts. To compare VA enrollee mortality on military specific characteristics, we used a DOD population standard.ResultsThe overall VA SMR of 2.8 (95% Confidence Interval [CI] 2.8-2.9), VA utilizer SMR of 3.2 (95% CI 3.1-3.3), VA non-utilizer SMR of 0.9 (95% CI 0.8-1.1), and DOD SMR of 1.5 (95% CI 1.4-1.5) provide no evidence of a HSE in any cohort relative to the US standard population. Relative to DOD, both the total VA population SMR of 2.1 (95% CI 2.0-2.2) and the SMR for VA utilizers of 2.3 (95% CI 2.3-2.4) indicate mortality twice what would be expected given DOD mortality rates. In contrast, the VA enrollees who had not used clinical services had 40% lower than expected mortality relative to DOD.ConclusionsNo support was found for the HSE among US veterans of OEF/OIF/OND. These findings may be attributable to a number of factors including post-deployment risk-taking behavior, an abbreviated follow up period, and the nature of the OEF/OIF/OND conflict.

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Section: Discussionmentioning

confidence: 99%

Erosion of the healthy soldier effect in veterans of US military service in Iraq and Afghanistan

Bollinger

Schmidt

Parsons

et al. 2015

Popul Health Metrics

View full text Add to dashboard Cite

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“…This is due to pre-employment screening and regular medical check-ups as well as self-selection. Scientific medical reports also contain the data on such "healthy worker" phenomenon [12][13][14]. Except coalminers operators constitut portion of AH patients.…”

Section: Resultsmentioning

confidence: 99%

Modeling of arterial hypertension’s risk in occupational groups

Maksimov¹,

Артамонова²

2013

RusOMJ

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Aim -Evaluate the influence of work environment on the risk of arterial hypertension (AH) development in employees of various social groups. Material and Methods -3664 employees of Siberian industrial enterprises and office workers were examined. Apart from occupation AH predictors were considered to be gender, age, Quetlet index, smoking, alcohol abuse, marital status and education. Classification trees were used as a method of predicting AH presence or absence. Results -A classification tree allowing 75% prediction of AH presence/ absence was obtained. Quetlet index (100), age (83) and occupation (63) were maximum significant predictors for classification. A structure of the classification tree changed in different age groups and; moreover, with similar prediction level the predictor significance differed greatly. In middle-aged population occupation along with Quetlet index was characterized by higher significance (89) while in elderly subjects the significance of occupation decreased (55) and the significance of education and marital status rose (60 and 34, respectively). Different AH prevalence was observed in the occupational groups with similar working conditions. Conclusion -Quetlet index, age and occupation are highly significant for AH prediction in working age population. Occupation is very significant for AH prediction in middle-aged patients. Other factors under study do not usually influence AH development much, though, with ageing their role gets more important.

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“…To complete the bias analysis, we checked the ‘healthy worker effect’ mentioned e.g. for US American chemistry workers [ 18 ] and workers of the nuclear production complex of Hanford Site [ 19 ]. From 19 studies mentioned, we found 7 with SMR information for nonradiation workers.…”

Section: Discussionmentioning

confidence: 99%

Renal Effects and Carcinogenicity of Occupational Exposure to Uranium: A Meta-Analysis

Stammler¹,

Uhl²,

Mayer

et al. 2016

Nephron Extra

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Purpose: Uranium is a heavy metal with alpha radioactivity. We state the hypothesis that uranium exposure is harmful to human kidneys and carcinogenic to body tissues. Therefore, we review epidemiological studies from people with known long-lasting uranium exposure. Materials and Methods: Three meta-analyses are performed using clinical studies published in the PubMed database and applying RevMan 5.3 from the Cochrane Collaboration to calculate the outcome. The first two meta-analyses examine the standardized mortality ratio (SMR) and the standardized incidence ratio for any cancers of uranium workers who were operating in areas ranging from uranium processing to the assembly of final uranium products. The third meta-analysis evaluates the nephrotoxic risk in uranium workers as well as soldiers and of individuals with exposure to drinking water containing uranium. Results: Overall and contrasting to our hypothesis, the tumor risk is significantly lower for uranium workers than for control groups (SMR = 0.90 with a 95% confidence interval of 0.84 to 0.96). In addition and also contrasting to our hypothesis, the risk of nephrotoxicity is not increased either. This holds for both the incidence and the mortality due to renal cell carcinoma or due to acute kidney injury or chronic kidney disease. In contrast, a significantly better creatinine clearance is found for the uranium cohort as compared to the control groups (mean difference = 7.66 with a 95% confidence interval of 0.12 to 15.2). Conclusion: Our hypothesis that a chronic uranium exposure is associated with an increased risk of cancer mortality or of kidney failure is refuted by clinical data. The decreased risk may result from better medical surveillance of uranium workers.

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The healthy worker effect in US chemical industry workers

Abstract: The low SMRs observed in this study are likely due to differential smoking between the cohort and the background population. Future considerations to control for the HWE should take this into account.

Cited by 13 publications

References 17 publications

Erosion of the healthy soldier effect in veterans of US military service in Iraq and Afghanistan

Erosion of the healthy soldier effect in veterans of US military service in Iraq and Afghanistan

Modeling of arterial hypertension’s risk in occupational groups

Renal Effects and Carcinogenicity of Occupational Exposure to Uranium: A Meta-Analysis

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